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<title>Ask PREPSKILLS Form</title>
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	name="action" value="askprepskills">
<table bgcolor="034016" border=0 cellpadding="0" cellspacing="0"
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		<table bgcolor="ffffff" border=0 cellpadding="2" cellspacing="0"
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				<td colspan="2" align="center"><img height="25" width="910"
					src="staticContent/images/bread_crumb_image.jpg" alt="Prepskills">
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				<td colspan="2">
				<h1 class="prepskillsorangetitle">PREPSKILLS thanks you for one
				Superb Referral!</h1>
				</td>
			</tr>
			<tr>
				<td colspan="2" class=prepskillsbody>Do you know a student or
				family that would benefit from PREPSKILLS programming? Let us know
				who they are and we will make sure to invite them to our next
				educational seminar.</td>
			</tr>
			<tr>
				<td colspan="2" class=prepskillsbody>COMPLETE IN FULL</td>
			</tr>
			<tr>
				<td colspan="2" class=prepskillsbody>WHO should we sent the
				invitation to?</td>
			</tr>
			<tr>
				<td>Contact Name: *</td>
				<td><input type="text" maxlength="128" id="editfullname"
					size="40" value="" /></td>
			</tr>
			<tr>
				<td>Last Name: *</td>
				<td><input type="text" maxlength="128" id="editfullname"
					size="40" value="" /></td>
			</tr>
			<tr>
				<td>First Name: *</td>
				<td><input type="text" maxlength="128" id="editfullname"
					size="40" value="" /></td>
			</tr>
			<tr>
				<td>Student Name: *</td>
				<td><input type="text" maxlength="128" id="editfullname"
					size="40" value="" /></td>
			</tr>
			<tr>
				<td>Grade: *</td>
				<td><input type="text" maxlength="128" id="editfullname"
					size="40" value="" /></td>
			</tr>
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				<td>Last: *</td>
				<td><input type="text" maxlength="128" id="editfullname"
					size="40" value="" /></td>
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			<tr>
				<td>First: *</td>
				<td><input type="text" maxlength="128" id="editfullname"
					size="40" value="" /></td>
			</tr>
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				<td>Address: *</td>
				<td><input type="text" maxlength="128" id="editfullname"
					size="40" value="" /></td>
			</tr>
			<tr>
				<td>Number and Street: *</td>
				<td><input type="text" maxlength="128" id="editfullname"
					size="40" value="" /></td>
			</tr>
			<tr>
				<td>City: *</td>
				<td><input type="text" maxlength="128" id="editfullname"
					size="40" value="" /></td>
			</tr>
			<tr>
				<td>Province: *</td>
				<td><input type="text" maxlength="128" id="editfullname"
					size="40" value="" /></td>
			</tr>
			<tr>
				<td>Postal Code: *</td>
				<td><input type="text" maxlength="128" id="editfullname"
					size="40" value="" /></td>
			</tr>
			<tr>
				<td>Email: *</td>
				<td><input type="text" maxlength="128" id="editemail" size="40"
					value="" /></td>
			</tr>
			<tr>
				<td>Primary Phone: *</td>
				<td><input type="text" maxlength="128" id="editprimaryphone"
					size="40" value="" /></td>
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			<tr>
				<td>Your Name: *</td>
				<td><input type="text" maxlength="128" id="editprimaryphone"
					size="40" value="" /></td>
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				<td>Date: *</td>
				<td><input type="text" maxlength="128" id="editprimaryphone"
					size="40" value="" /></td>
			</tr>
			<tr>
				<td width="250px;">Which program(s) might they be interested
				in?</td>
				<td><select id="editquestioncatergory">
					<option value="" selected="selected">select...</option>
					<option value="SSAT">SSAT and Private School Admissions</option>
					<option value="SAT/ACT">PrepEssentials T (PrepThink
					T/PrepWriteT/PrepSpeakT/PrepLeaderT)</option>
					<option value="Other">SAT and American College Admissions</option>
				</select></td>
			</tr>
			<tr>
				<td>Send a personalized message to your referral? We will
				include it in our invitation.</td>
				<td><textarea cols="72" rows="2" id="yourquestions"></textarea></td>
			</tr>
			<tr>
				<td colspan="2"><input type="submit" name="op" id="editsubmit"
					value="Submit" onclick="submitForm();" /></td>
			</tr>
			<tr>
				<td colspan=2>
				<p class=prepskillsbody>Thank you for recommending PREPSKILLS!
				We thrive on word of mouth referrals. In fact, over 85% of our
				clients are referred to us by a friend, teacher, guidance counselor,
				coach or educational consultant.</p>

				<p class=prepskillsbody>If your friend enrolls in a PREPSKILLS
				program, you will receive either a $50 Visa Gift card or PREPSKILLS
				will make a $50 donation on your behalf to Childhood Cancer Canada,
				through the PREPSKILLS <a href="http://www.wingsofhope.ca/">Wings of Hope<sup>TM</sup></a> Initiative.</p>

				<p class=prepskillsbody>Complete this form for each friend who
				you think might be interested in our SSAT, PREPEssentials or SAT
				(and related) programming. Make sure your friend mentions your name
				when enrolling!</p>
				</td>
			</tr>
		</table>
	</tr>
</table>
</form>
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